PEN 10 THE THIRTEENTH ANNUAL REPORT of thE School Medical Officer for the URBAN DISTRICT OF PENGE in the COUNTY OF KENT, for the Year ending 31st December, 1920. THE THIRTEENTH ANNUAL REPORT of the School Medical Officer for the URBAN DISTRICT OF PENGE in thb COUNTY OF KENT, for the Year ending 31st December, 1920. P. B. Beddow, “Press” Printing Worlis, Anerley, S.E. Arban District Council of Penge Education Committee. MEMBERS. Chairman: The Rev. Ernest J. Barson. Deputy-Chairman: Mr. A. F. Boyer. MEMBERS OF THE COUNCIL. Mr. G. J. Gully, J.P. (Chairman of the Council, ex officio.) Mr. H. Culver. Mr. W. Dommett. Mr. J. Edwards. Mr. F. W. Foreman. Mr. F. P. Hodes. Mr. E. G. Hopper. Mr. D. Jones. Capt. W. Marr. Mr. W. C. Watling, J.P. Mr. F. W. R. Young. REPRESENTATIVE MEMBERS. The Rev. Ernest J. Barson. Mr. A. F. Boyer. Mr. T. Clarke. Miss F. Moore. Mr. F. Walter Payne, J.P. Miss M. Turner. Mrs. N. Watling. SCHOOL MEDICAL OFFICER. William Adams Clark, M.D. Lond., M.R.C.S., L.R.C.P. Eng. MEDICAL INSPECTORS. Ernest George Pringle, M.D. Lond., M.R.C.S., L.R.C.P. Eng. Arthur Scott Turner, M.R.C.S., L.R.C.P. Eng. SCHOOL DENTAL SURGEONS. D. Harold Barr, L.D.S. J. Henry C. Davis, L.D.S. SCHOOL NURSES. Miss M. Linford Brown. Miss E. Johnson. CLERK TO THE COMMITTEE. C. G. Liddle. The Town HalL, Anerley, S.E. To the Chairman and Members of the Education Committee of the Urban District Council of Penge. Ladies and Gentlemen, I have the honour of presenting to you the Thirteenth Annual Report on the Medical Inspection of children in attendance at the Elementary Schools in the district for the year ending December 31st, 1920. The Report has been made according to the requirements of the Board of Education, Tables 1 to VI being compiled as directed. The form of Table IV has been altered, fuller details being required, and the Summary forms Table V. Table VI, which replaces Table V of former years, is also more detailed The Schools under the control of the Committee are five in number:— Official No. School. Built. Accommodation. Average No. on Roll. Average Attendance. l. Melvin Road 1881 1193 1079 954 2. Oakfield Road 1900 934 1173 1034 3. St. Anthony's 1898 124 143 121 4. St. John's— Croydon Road 1837 742 779 688 Maple Road 1861 5. St. Paul's 1869 199 228 194 The work of Medical Inspection has been carried out as before in the afternoons —by Dr. Adams Clark on Tuesday, Dr. Pringle on Wednesday, and Dr. Scott Turner on Thursday. Mr. D. Harold Barr attends for Dental Work on Tuesday and Thursday mornings throughout the school terms. On September 1st Mr. J. Henry C. Davis, L.D.S., commenced Dental Work on two additional mornings (Monday and Wednesday) of each week. Miss E. Johnson began work on September 1st as a second School Nurse. Medical Inspection of the children is now an accepted part of school life, and many parents appreciate the benefit of it, and the treatment that is provided. At the Routine Inspections 1,301 children were examined; there were 255 specials examined, and 369 children were re-examined as frequently as required to supervise progress and to ascertain the result of treatment recommended. 6 TABLE I. Number of Children inspected 1st January, 1920, to 31st December, 1920. " A."—ROUTINE MEDICAL INSPECTION. Entrants. Intermediate Groups. Leavers. Age— 3 4 5 6 7 9 10 11 Total. 8 12 13 14 Total. Grand Total. Boys 3 49 131 48 17 50 15 18 331 160 159 22 5 186 677 Girls – 32 126 44 15 18 19 19 273 106 192 51 2 245 624 Totals 3 81 257 92 32 68 34 37 604 266 351 73 7 431 1,301 “B.”—SPECIAL INSPECTIONS. Special Cases. Re-examinations (i.e., No. of Children re-examined. Boys 117 172 Girls 138 197 Totals 255 369 "C."—NUMBER OF " INDIVIDUAL " CHILDREN INSPECTED. 1,556, 7 TABLE II.—Return of Defects found in the Course of Medical Inspection in 1920. ROUTINE INSPECTIONS. SPECIALS. Defect or Disease. Number referred for treatment. Number tequiring to be kept under observation, but not referred for treatment. Number referred for treatment. Number requiring to be kept under observation, but not referred for treatment. Malnutrition - 5 - - Uncleanliness: Head 66 - 9 - Uncleanliness: Body 9 - 5 - Skin—Ringworm: Head - 1 14 - Ringworm: Body - - 16 - Scabies 7 - 14 3 Impetigo 1 - 14 - Other Diseases (Non-Tubercular) l 2 3 11 3 Eye—Blepharitis 9 - 1 - Conjunctivitis 2 - 5 - Keratitis 4 - 1 - Corneal Ulcer - - - - Corneal Opacities 3 - - - Defective Vision 102 - 12 - Squint 14 1 1 - Other Conditions - - 3 - Ear—Defective Hearing - 11 2 - Otitis Media 4 - 1 - Other Ear Disease - 1 7 - Nose and Throat—Enlarged Tonsils 30 - 1 1 Adenoids 32 - 2 1 Enlarged Tonsils and Adenoids 12 - 2 1 Other Conditions 12 - 14 6 Enlarged Cervical Glands (NonTuberculous) - 52 6 2 Defective Speech - 5 - - Teeth—Dental Diseases - - 8 - Heart and Circulation— Heart Disease: Organic - 23 1 1 Heart Disease: Functional - 2 1 - Anaemia - 9 - - Lungs—Bronchitis 2 2 5 1 Other Non-Tubercular Diseases - - 3 3 Tuberculosis—Pulmonary : Definite 2 1 3 - Pulmonary: Suspected 1 1 4 - Non-Pulmonary:— Glands 3 1 5 - Spine 2 1 - - Hip - 9 2 - Other Bones and Joints - - 1 - Skin - - - - Other Forms - 1 2 - Nervous System—Epilepsy 3 - 3 - Chorea - - - - Other Conditions 2 3 9 1 Deformities—Rickets 2 1 2 - Spinal Curvature - 3 - - Other Forms - - 13 - Other Defects and Diseases 3 3 44 8 Number of Individual Children having defects which required Treatment or to be kept under observation—392. 8 An increase is found over the previous year in defects referred for treatment, notably under the headings of "Vision" and "Squint," and " Nose and Throat." No further improvement is to be reported as to cleanliness. A certain residue of children relapse into uncleanliness, even when made clean by baths at the cleansing station, their home conditions being adverse to cleanliness. In one school all the boys were clean at the Routine Medical Inspection, in another school more than half the girls had nits present in the head when examined by the School Nurse. A few children have been referred for special observation ; thirty children out of those with 132 defects reported in Column 3 of Table II. The dental defects now come under the regular inspection of the School Dentists. Children beyond the age for dental inspection, but recommended by the Medical Inspectors, are seen as Specials at the Dental Clinic. The general condition of the children continues good. The Penge Recreation Ground has been available since last summer for classes in the open air for the scholars of St. John's Infants' and Girls' Departments. The School adjoins the Recreation Ground. Infants up to the age of six have games and drill there for twenty minutes every day, those from six to eight years old go twice a week for half an hour. The Head Teacher reports that these children have been more alert, and that the school attendance has been better since this privilege was granted. It is much appreciated by children and teachers. The Girls use the grounds similarly three afternoons in the week. TABLE III.—Numerical Return of all Exceptional Children in the Area in 1920 Boys. Girls. Total. Blind (including Partially Blind):— Attending Public Elementary Schools 3 6 9 Attending Certified Schools for the Blind 2 2 4 Not at School — — — Deaf and Dumb (including Partially Deaf):— Attending Public Elementary Schools 1 2 3 Attending Certified Schools for the Deaf 3 — 3 Not at School — — — Mentally Deficient:— Feeble-Minded: Attending Public Elementary Schools 4 4 8 Attending Certified Schools for Mentally Defective Children 2 2 4 Notified to the Local Control Authority by Local Education Authority during the Year — — — Not at School — — — Imbeciles: At School — — — Not at School 1 — 1 Notified to the Local Authority Control during the Year 1 — 1 Idiots — — — Epileptics:— Attending Public Elementary Schools 1 5 6 Attending Certified Schools for Epileptics 1 — 1 In Institutions other than Certified Schools — — — Not at Schools — — — Physically Defective:— Pulmonary Tubercular: Attending Public Elementary Schools 3 2 5 Attending Certified Schools for Physically Defectives — — — In Institutions other than Certified Schools — 1 1 Not at School — — — Physically Defective (Continued):— Boys. Girls. Total. Crippling due to Tuberculosis: — — — Attending Public Elementary Schools — 1 1 Attending Certified Schools for Physically Defectives — — — In Institutions other than Certified Schools 2 1 3 Not at School 1 5 6 Crippling due to Causes other than Tuberculosis, i.e., Paralysis, Rickets, Traumatism: Attending Public Elementary Schools 6 — 6 Attending Certified Schools for Physically Defective — ^— — In Institutions other than Certified Schools — — — Not at School — — — Other Physical Defectives, e.g., Delicate and Other Children Suitable for Admission to Open-Air Schools, Children Suffering from severe heart disease: Attending Public Elementary Schools 15 15 30 Attending Open-air Schools — — — Attending Certified Schools for Physically Defective Children other than Open-air Schools Not at School — — — Dull or Backward:— Retarded two years 17 32 49 Retarded three years 24 21 45 One child was notified by the Local Education Authority to the Local Control Authority ; he was certified as an imbecile. The condition at the end of the year of the boy seen on February 5th, in consultation with the Medical Officers of the Board of Education, is improved ; if the improvement continues, he will be able to attend school in a few months. The teaching of the dull and backward children would be greatly helped by the formation of a special class or classes, where the supervision and training needed by these children could be given. Facilities for teaching in the open air for delicate and backward children is recommended as a provision that is most desirable when the opportunity arises. TABLE IV.—"A"-—Treatment of Minor Ailments. Disease or Defect. Number of Children Total. Referred for Treatment. Treated Under Local Education Au. thoritv's Scbeme Otherwise. Skin:— Ringworm: Head 26 25 1 26 Ringworm: Body 25 22 3 25 Scabies 47 43 4 47 Impetigo 154 138 16 154 Minor Injuries 60 60 — 60 Other Skin Disease 171 168 3 171 Ear Disease 49 48 1 49 Eye Disease (External and Other) 62 59 3 62 Miscellaneous 100 88 12 100 10 “B.”—Treatment of Visual Defects. Number op Children. Submitted to Refraction. Referred for Refraction. Under Local Education Authority's Scheme, Clinic or Hospital. By Private Practitioner or Hospital. Otherwise. Total. For whom Glasses were prescribed. For whom Glasses were provided. Recommended for Treatment other than by Glasses. Received other forms of Treat, ment. For whom no Treat, ment was considered necessary. 129 89 13 102 102 102 3 2 2 " C."—Treatment of Defects of Nose and Throat. Number of Children. Referred for Treatment. Received Operative Treatment. Received other forms of Treatment. Under Local Education Authority's Scheme —Clinic or Hospital. By Private Practitioner or Hospital. Total. 87 6 28 34 35 "D."—Treatment of Dental Defects. (1) Number of Children dealt with. Age Groups. Specials. Total. 5 6 7 8 9 10 11 12 13 14 (a) Inspected by Dentist 1,816 (b) Reterred for Treatment 1,413 - 1,413 (c) Actually Treated 600 101 701 (.d) Re-treated (result of Periodical Examination - - - (2) Particulars of Time given and of Operations undertaken. No. of Half-da; devoted to Inspection. ys No. of Half.days devoted to Treatment. Total No. of Attendances made by the children at the Clinic. No. of Permanent Teeth. No. of Temporary Teeth. Total No. of Fittings. No. of Adminis. trations of General Anesthetics included in (4) and (6). No. of other Operations. Extracted. Filled. Ex. tracted Filled. Perma. nant teeth. Teinporary teeth. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) 8 103 1407 86 375 1536 386 761 18 37 The Minor Ailments Clinic has been held on Fridays, at 2.30 p.m., at Oakfield Road School, by Dr. Scott Turner and Dr. Adams Clark, in the room set apart for Dental Treatment and this Clinic. The number of children attending during 1920 was 694. The total number of attendances was 1,195, which is 25 per cent, more than in 1919 and 85 per cent, more than in 1915, the first complete year, January to December, of the Clinic. Some trivial cases come to the Clinic, but many needing constant care and attention are treated ; the majority of these in former days would only have had the attention which a busy mother could give, or the disease would be allowed to run its course without treatment. There were fifteen cases of ringworm of scalp treated during the year, six girls and nine boys. Nine treated by X-Rays, and four treated by drugs, were cured, 11 and two remained under treatment. All these were brought before the Medical Inspectors as Specials. Dr. Critchley states that the number of cases of strabismus seems unduly large, larger than the proportion of such cases has been found to be among fifty thousand children examined by him in the London Committee's area. He cannot attempt to assign any reason for this unless it be that distance from Penge to hospitals is sufficient to hamper parents' energy in going to seek advice at the earliest possible time. In the coming year a considerable number of children treated by Dr. Critchley will be due for re-examination by him, and unless this is attended to the intended and hoped for benefits will not result. The treatment of throat cases by operation was in several instances carried out at the Norwood Cottage Hospital by Dr. Scott Turner. Six accepted treatment by operation in London out of the eighty-seven referred for treatment. Just 40 per cent, were operated on, and 40 per cent, received other forms of treatment. THE DENTAL CLINIC. To the Chairman and Members of the Education Committee of the Urban District Council of Penge. Ladies and Gentlemen, We have the honour to present to you the Eighth Annual Report of Inspections and Treatment carried out in connection with the Dental Clinic. Since your appointment on September 1st of an additional part-time dental surgeon, treatment is available on four mornings in each week. The age-limit was raised to twelve—that is, the teeth of all children between the ages of five and twelve are periodically examined, and treatment is undertaken where necessary, and when the consent of the parents is obtained. In addition, under your present scheme, a number of older children, specially recommended by the School Medical Staff have received treatment, and also a number of children over eleven years of age who in previous years have been examined and treated. I.—Number of Children dealt with. Age group Special 5-12. Cases. Totals. (a) Inspected 1,816 — 1,816 (b) Referred for Treatment * 1,413 — 1,413 (c) Actually treated 600 101 701 * i.e., 77.8 per cent. 12 II.—Particulars of Time given and of Operations Undertaken. Number of half-days devotf d to Inspection. Number of half.days devoted to treatment. Total Number of A tendances made by the children for treatment. Number of Permanent Teeth. Number of Temporary Teeth. Total Number of Fillings. Number of Administrations of general Anaesthetics Number of other operations. Extracted. Filled. Extracted. Filled. 8 103 1,407 ?6 375 1,536 386 761 18 57 The work of the Clinic has been very greatly assisted by the able help of Miss Linford Brown, the School Nurse, which we would gratefully acknowledge. D. Harold Barr, L.D.S., R.C.S. Eng. J. Henry C. Davis, L.D.S., R.C.S. Eng. In 1919, 80 3 per cent, of those inspected by the School Dentist were referred for treatment, as against 77'8 per cent, this year. All children who accept treatment when within the age-limit are entitled to the privilege of treatment until they leave school, although they may be above the age-limit. With regard to the Treatment of Uncleanliness, the average number of visits made to each school by the School Nurses was as follows :— No. 1, 80. No. 2, 70. No. 3, 30. No. 4, 20. No. 5, 30. It is estimated that 8,115 examinations of children were made by the School Nurses, and that 400 children were found to be unclean. If a child is found unclean, a notice of the condition is sent to the parent or guardian on a white card, with instructions as to how to treat it ; if the condition is not improved at a later examination, a red card is sent with instructions ; when required, this is followed by the notices necessary for compulsory cleansing to be carried out. The Cleansing Scheme, with the baths at the Cleansing Station, works well and without friction. During the year twenty boys and twenty-five girls had one hundred and thirty-five baths in all, this number including two boys and one girl with scabies. There were no compulsory cleansings and no prosecutions during the year. The working of the scheme so smoothly is owing to the tact and kindliness of Miss Linford Brown, the School Nurse, in dealing with the children. Her colleague, Miss E. Johnson, is carrying on the work in the same spirit. Bathing facilities at the schools for all the children would greatly benefit the scholars, and incidentally improve school attendance and assist the campaign against uncleanliness. The number of children referred for other defects than those enumerated in Table IV (A) (B) (C) (D), and for uncleanliness is ninety-six. Some of these are treated by attendance under the Medical Inspectors; in the cases of heart disease, for example, the amount of exercise allowed is regulated. Children with ear discharge are seen daily by the School Nurse at the Clinic, or when she visits the School. All cases needing care at home or at hospital are referred to the medical attendant of the family, or (in cases where the parents cannot provide attendance at home) to hospital, for treatment. Of the ninety-six children "referred," forty were treated under the Local Education's Authority's scheme, and thirty-eight were treated otherwise. *3 TABLE V. Summary of Treatment of Defects, as shown in Table IV (A), (B), (C) and (F), but excluding (E). Number of Children Disease or Defect. Referred for Treatment. Treated Total. Under Local Education Authority's Scheme. Otherwise. Minor Ailments 694 651 43 694 Visual Defects 129 89 13 102 Defects of Nose and Throat 87 6 63 69 Dental Defects 1,413 701 — 701 Other Defects 96 40 38 78 Totals 2,419 1,487 157 1,644 TABLE VI.—Summary relating to Children Medically Inspected at the Routine Inspections during the Year 1920. (1) The total number of children medically inspected at the routine inspections 1,301 (2) The number of children in (1) suffering from:— Malnutrition 117 Skin Disease 18 Defective Vision (including Squint) 178 Eye Disease 24 Defective Hearing 21 Ear Disease 14 Nose and Throat Disease 76 Enlarged Cervical Glands (Non-Tubercular) 48 Defective Speech 17 Dental Disease 18 Heart Disease: Organic 23 Heart Disease: Functional 8 Anaemia 9 Lung Disease (Non-Tubercular) 3 Tuberculosis:— Pulmonary: Definite 1 Pulmonary: Suspected 5 Non-Pulmonary 3 Disease of the Nervous System 5 Deformities 50 Other Defects and Diseases 41 (3) The number of children in (1) suffering from defects (other than uncleanliness, or defective clothing, or footgear) who require to be kept under observation (but not referred for treatment) 30 (4) The number of children in (1) who were referred for treatment (excluding cleanliness, defective clothing, etc.) 312 (5) The number of children in (4) who received treatment for one or more defects (excluding uncleanliness, defective clothing, etc.) 249 14 Review of the Action to detect and prevent the Spread of Infectious Disease. The Schools have been free from Infectious Disease beyond occasional cases throughout the year. The Medical Officer of Health and the School Medical Officer have met and consulted together regularly. In March when the question of a possible influenza epidemic was discussed, it was arranged that a circular should be sent to the Head Teachers informing them that, should the epidemic occur, disinfectants could be obtained at the Town Hall in the mornings, that vaccines were available, that nursing, when necessary, was arranged for, and that the schools would be disinfected as required. On February 5th, at the Town Hall, Dr. Eicholz and Dr. Janet Campbell, from the Board of Education, met Dr. Pringle and Dr. Adams Clark in consultation on the case of a boy who was regarded as unsuitable for attendance at school because of physical and mental defect. It was decided that the boy was to be kept under supervision by the School Medical Officer, and to be excused from school. The School Medical Inspectors and School Medical Officer met the Surveyor on February 2nd, and discussed the plans for the new building for the Clinic, which is to be established at 17, Oakfield Road. On July 9th, Dr. Muriel Bywaters met the Clerk of the Education Committee and the School Medical Officer and inspected the plans for the house and extension at 17, Oakfield Road. Estimates for equipping the new Centre have been prepared by the School Medical Officer, with the assistance of Dr. Pringle, Dr. Scott Turner, Dr. Critchley and Mr. Harold Barr. In July arrangements were made by the School Medical Officer with the School Medical Officer of Croydon that each Authority should follow up children attending the School of that Authority, although residing in the district of the other, thereby avoiding much correspondence and delay. This method of procedure is also followed between the Penge and Beckenham authorities. The number of employed school children examined in 1920 was 158. All were found fit to continue their work. Table III has been compiled by the Medical Inspectors and School Medical Officer, with the assistance of the Head Teachers and Miss Linford Brown. I have to acknowledge the ready help of all who are engaged in the School Medical and Dental Service in preparing the figures for the new tables. Again I have to express the appreciation of the School Medical Staff, of the cordial co-operation of the Teachers and of the work of both the School Nurses. This is of the greatest value, especially that done by Miss Linford Brown, whose knowledge and experience of the children is so full. The Clerk of the Authority and his Assistant are also thanked for all the assistance they have given. W. ADAMS CLARK, M.D., April 1 st, 1921, School Medical Officer.